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After a critical illness, exercise or physical therapy most consistently improved physical function after hospital discharge

Calvo-Ayala E, Khan BA, Farber MO, et al. Interventions to improve the physical function of ICU survivors: a systematic review. Chest. 2013;144:1469-80.

Review question

In adults who survive a critical (life-threatening) illness, can treatments help improve physical functioning after hospital discharge?

Background

People who are critically ill are usually cared for in intensive care units.

After a critical illness, many people have problems with physical function (e.g., walking and ability to do everyday things without help, such as bathing or moving about) for up to 5 years.

How the review was done

The researchers did a systematic review, searching for studies published up to 2012.

They found 14 randomized controlled trials with 7,417 people (average age 48 to 66 years, 44% to 72% men). People with excluded if they had a brain injury, were being treated for a specific condition (e.g., heart problems), or were in a long-term, acute care hospital.

The key features of the study were:

  • people were at least 18 years old and were in an intensive care unit;
  • most treatments involved exercise or physical therapy; other treatments included drugs, follow-up programs led by nurses, or changes in the treatment process; and
  • most treatments were compared with usual care, although some were compared with other treatments or no treatment.

What the researchers found

Compared with usual care, no treatment, or other treatments, exercise or physical therapy improved quality of life physical function scores, distance walked, and ability to do everyday things after hospital discharge in some trials but not all.

Drugs, follow-up programs led by nurses, or changes in the treatment process did not improve any measures of physical function.

Conclusion

In people who survive a critical illness, exercise or physical therapy most consistently improved physical function after hospital discharge.

Treatment vs usual care, no treatment, or a different treatment in people who survive a critical illness

Treatment

Number of trials (people)

Outcomes at hospital discharge or up to 12 months after hospital discharge

 

 

Effect on distance walked

Effect on quality of life physical function score

Effect on ability to do everyday things

Exercise or physical therapy*

7 trials (678 people)

Improved in 3 trials; no effect in 2 trials

Improved in 2 trials; no effect in 2 trials

Improved in some measures but not others in 3 trials

Follow-up program led by nurses

2 trials (620 people)

Not studied

No effect in 2 trials

No effect in 1 trial

*Exercise and physical therapy were usually part of a rehabilitation program.

 




Glossary

Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.

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